- Olanzapine is a second generation antipsychotic agent that acts on multiple receptors (incl. serotonin and dopamine receptors), resulting in sedation
- Onset of effect usually ~ 10 mins.
- Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.
- Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective
- Patient is able to tolerate or self-administer an oral wafer
- Preferred first line sedation agent in frail patients and those with Dementia
- Known Allergy
- Known Parkinsons Disease
- Age < 6 years old
- Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia,
Hypoglycaemia, etc
- Dementia patients – apply caution. Use lower doses
- Oral dispersible tablet may be dissolved in water (may slightly delay onset of action but still preferable in non-emergent cases)
- ‘Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
- Sedation is HIGH RISK – must only be carried out after careful deliberation between officers and must not be based primarily at the request or influence of other agencies on scene (e.g. Police etc.)
- Positive RASS score does not automatically infer a need to sedate
- Age <16 years old – sedation should prompt a prior ASMA consult wherever practicable
- ETOH / Intoxication – apply caution
- Repeat & Maintenance doses – have a low threshold to consult with ASMA where repeat or maintenance doses are required
- Monitoring – SpO2 and EtCO2 monitoring must be applied whenever level of consciousness drops (~RASS -2 or below)
- Positioning – DO NOT transport in supine position (increases risk of laryngospasm from secretions) – transport in lateral position
- Airway & Breathing – monitor airway and breathing effort, including chest movement closely for signs of impairment. Prepare to support if required
- Restraint – Prone and/or handcuffed to rear carries excessive risk and MUST NOT occur. Physical restraint in any position that amplifies the risk of positional asphyxia, must be closely observed for signs of air hunger and hypoxia
- RASS scores must be agreed and documented
- Weight – Estimated weight must be agreed before administration of any weight based medicines. This must be documented
The final decision to sedate lies with the most senior clinician on scene
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Oral Olanzapine for sedation
Adults < 70 years old:
- 10 mg
- Repeat as necessary after 15 mins to maximum cumulative dose 20 mg/24 hrs (via all routes).
Adults > 70 years old or frail:
- 5 mg
- Repeat as necessary after 15 mins to maximum cumulative dose 10 mg/24 hrs (via all routes).
Paediatric 6 - 15 years old, > 40kg:
- 5 - 10 mg
- Repeat as necessary after 15 mins to maximum cumulative dose 20 mg/24 hrs (via all routes).
Paediatric < 40kg
- ASMA consult required
- Extrapyramidal effects / Dyskinesia
- Increased falls risk
- Hypotension – Apply monitoring as soon as practicable
5 mg Oral Dispersible tablets in blister pack
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